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Radiographic Outcomes In Nonoperatively Treated Salter Harris II Distal Radius Fractures
TJ Ridley, MD1; Christina Ward, MD2; John Wechter, MD2
1University of Minnesota, St Paul, MN, 2Regions Hospital, St Paul, MN
Introduction: Although Salter Harris II (SHII) distal radius fractures (DRFs) occur commonly, no clear treatment guidelines exist. Our primary objective was to determine if specific patient or fracture characteristics were associated with malunion after SHII distal radius fracture.
Methods: We conducted a retrospective review identifying all patients 18 years of age or younger who underwent non-operative treatment of SHII DRF at our institution between 2005 and 2015. We recorded patient age, sex, and mechanism of injury. We measured articular surface volar tilt, epiphyseal translation, and ulnar variance on injury, post-reduction and final follow-up radiographs. Fractures grouped into dorsally or volarly angulated categories for subsequent analyses. For dorsally angulated fractures, malunion was defined as any dorsal tilt beyond 0 degrees or positive ulnar variance on final films. For volarly angulated fractures, malunion was defined as >10 degrees of volar tilt or positive ulnar variance.
Results: The study group included 130 patients (99 males, 31 females) with a mean age 12.2 years (range 4.4-18.1 years) and an average follow up of 197.1 days. Forty eight percent (62/130) of all fractures met criteria for malunion at final follow up with rates in the dorsally and volarly angulated groups 50% (56/112) and 33.3% (6/18), respectively. Incidence of malunion in both the dorsally and volarly angulated subgroups was not significantly correlated with initial dorsal tilt, initial translation, post-reduction dorsal tilt, post-reduction translation, post-reduction ulnar variance, mechanism of injury or age at time of injury (p > 0.05 for all analyses). Of the 42 patients with final radiographs >180 days from injury (mean 483 days, range 184-1819 days), 36 had initially dorsally angulated fractures and 6 had volarly angulated fractures. Of the dorsally angulated group, 21 fractures met criteria for malunion. Patients with malunions had a higher mean age at the time of injury than those without malunion (12.8 vs 10.7 years, p=0.02).
Conclusion: Based on these criteria for malunion, we identified high malunion rates (47.7%) in SHII distal radius fractures treated nonoperatively. Malunion was not associated with initial displacement, post-reduction displacement, mechanism of injury. Malunion was correlated with age at time of injury in dorsally angulated fractures followed >180 days.
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